| NPI | 1679847784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON W AHLSTROM Owner 435-753-1545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 4918766-1205) |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2012-03-07 |